Suppose there’s a new treatment for a specific kind of deafness, and this treatment can’t happen without you, the dentist. But there’s a vicious cycle at play preventing all the parts from hooking up and delivering the appropriate patient care.

Would an ENT physician ever admit to being intimidated by a new product because it meant that they’d have to partner with a dentist to deliver the treatment? Are they afraid of their own ignorance about dentistry?

Why then, out of thousands of ear, nose, and throat physicians, audiologists, and other hearing specialists, are only a handful of clinics offering what looks like to be a breakthrough product? Currently about 70 medical practices are listed at the Sonitus website. If you exclude the 13 practices in New York and the 9 in California, that means that the rest of them are scattered around the country at an average of less than one per state.

Can you imagine if you were the only dentist in your entire state who was working with an audiologist?

Well then.

Physician referrals sometimes make for the best patients. I mean, the patient trusts their doctor already. It’s easy for the patient to transfer that trust to you, especially if you’re partnering with that person.

Admittedly, this is looking at the situation from a dental-centric side: what’s in it for you. Right?

New patient flow aside, let’s go to the patient, the problem, and the product for a moment.

The patient: usually younger than the average person needing a hearing aid. As young as eighteen; average age? Mid-forties.

The problem: single-sided deafness. One ear works pretty well, the other one, pretty badly. Having hearing only in one ear can be more devastating than you might imagine. While not as difficult as total deafness, single-sided hearing loss means that the “good ear” must be turned towards the sound origin which can result in loss of eye contact when listening to conversations, having to choose seating where no one will be able to sit next to the patient’s “bad ear,” dysphoria related to sound confusion, and many other issues which affect quality of life.

The product: It really is called…. wait for it…

A Soundbite.

Beautiful. Here’s how it works:

The receiver reminds me a little bit of those old Nesbit spider partials that dentists no longer seem to make because of the fear that they will be swallowed. No sharp pointy pieces to snag in the gut, however. Um… yay?

So for those who are candidates for the SoundBite, what other options do they currently have? How about a titanium implant? Boy, that rings a bell (Ha! audiology humor). Seriously, for about $10,000 a titanium fitting is surgically implanted into the bone behind a patient’s deaf ear and a sound processor is attached to it which sends vibrations into the skull. Another option is to wear a microphone in the deaf ear and the receiver in the other one. But audiologists say that patients who can hear normally in one ear really have a problem with anything impeding the healthy ear’s function and definitely don’t want to wear two hearing aids.

It’s not a perfect solution due to the changes some users have noticed with eating and speaking, but those who have been fitted with the SoundBite have been extremely happy with the improvement in their hearing and feel like the small inconveniences are totally worth the life-changing effects of their new device. Imagine! The microphone picks up the sound of fingers snapping in a deaf ear, and the transmission through the tooth tricks the brain into thinking it’s hearing again! The cost is upwards of $6000, and batteries must be kept charged and changed after eight hours of continuous use.

Don’t you want to help now? Of course you do. You can click over to the SoundBite website, read this information for dentists, and even sign up to become a provider. But I have a better challenge. There’s probably an ENT or audiologist in your own zip code. Let them know that you’ve read up on this product, you might have even watched the video below, and that you would love to work with them to help patients manage their hearing loss. They won’t do it without your interest.

Hygienists already know all about this sound conduction. Just ask anyone who regularly uses ultrasonic scalers if patients hear a “feedback” tone that is very, very loud when the distal of the upper left molar is cleaned. It might happen with other dental techniques as well, but since I’m not down in the roots or cutting enamel off of teeth as regularly as I screech along the gumlines of able-eared people, I don’t know.

As a patient, though, I don’t hear this ultrasonic wail any more. Last time I had my teeth cleaned the tone was gone, as I suspected it would be. And that is the whole reason for even discovering the SoundBite.

I happen to be one of those patients with single-sided deafness; my hearing disappeared suddenly, with no known reason. I awoke one morning with a roar in my left ear. I thought that this new horrendous white noise was the problem, it was so loud, I figured it would go away soon enough, so I tried to ignore it. When it didn’t, and then I made the shocking discovery when I turned my right ear away from music that it faded away…well, that’s when I realized I needed a specialist. It wasn’t just tinnitus; it was the absence of sound. And it sucked, like a vacuum cleaner. Literally.

Even though the bad news from my ENT was that the hearing was diminished and not likely to come back, the good news was that it wasn’t gone completely. I started searching for solutions, just in case I did go totally deaf in that ear, and that’s when I discovered that my very own dentist! my employer! could! help! me!

When you think about it as a professional, isn’t this awesome?

I’m thankful to still have a decent amount of hearing in my bad ear, and despite the fact that noises are garbled and tinny-sounding, I’m going to do my best without a SoundBite for the moment. However, there are many, many patients out there with total ear deafness that could benefit from one. All they’re missing is a dentist who can take a good impression.

Do you know how sometimes, when you get a new piece of equipment, it’s so Shifta La Paradigma that you can’t even THINK about working without it? You get a little anxious about the possibility of it failing and having to go back to the old way of doing things. What do you do?

You get yourself a backup, right? hoping that your original will keep going until FedEx arrives with your precious cardboard salvation. But then you realize that the backup is so Next Generation, your OLD one ends up becoming the backup. And that’s where I am with my Lumadent headlight. I have the old, the new, and opinions about them both, which are the real reasons you’re here. So let’s get to those, shall we?

Opinion #1: It’s Bright, Baby.

Not only is the Lumadent headlight well-focused and a good color, its shadowless light means that more photons are hitting your retinas, therefore the mouth that you’re looking at may be ACTUALLY MORE GROUNDED in reality. If you can’t see something, it’s not there.

Since I haven’t used any other lights except the Lumadent consider this a broad endorsement for headlights over any other sort of overhead illumination. Just about all of them have some sort of knob that will allow you to adjust the intensity, and I find that I rarely turn the Lumadent’s control any more or less than to the halfway position. I’ve learned how to control my head so that the light doesn’t shine in my patient’s eyes (unless I’m gesticulating wildly, then they might see a few blinding streaks) and the super bright just isn’t necessary most of the time. Also included is a flip-up composite filter to keep your accidental light curing to a minimum. I’ve heard some concerns about LEDs damaging user’s eyes over time which is one reason I tend to keep the power down, but don’t seem to have any problems with eyestrain in the two years I’ve been using one. The new model seems to be just as bright and as clear as the older one, so no change in this most important feature.

Opinion #2: Cords are better. And worse.

But mostly better. I’ll explain. The cord replacement is much easier now that the light detaches completely from it. They’ve also switched to a longer initial cord which means that I don’t have to keep a too-long extension hanging around or knotted up in a tie wrap. You’ll notice that the plug-in at the battery has changed to a right-angle which should keep the tension off the cord. I was KILLING my extensions contacts and the light would flicker and just short out and be a huge pain.

What I’m less than thrilled with is the way that the right-angle attaches to the light itself. If you end up with a short in the new cord now, all you do is detach it right there, loupside, leave the light on the loupe, and plug in a new cord. But the cord sticks up at a weird angle and I’m forced to use yet another tiny tie-wrap to keep those wires from getting tangled in my hair and attached close to the frames. The other thing I do like is that the lens is easier to access and clean now that it’s not recessed. It’s the one on the left in this image.

Opinion #3: This battery pack is serious.

My original battery pack served me well and would stay charged for a whole day, but its slick case in a sassy leather pouch clip probably caused the short outs due to occasional detachment problems. Not the clip, just the battery itself would skittle across the floor when I had a “way to go, Grace” moment.

Now that I have two batteries I forget to charge the new silver one, but I have yet to have it clunk out on me and switching back to the black one for backup. Once you go silver….

So this pack is so serious, it’s like Chuck Norris, it has it’s OWN clip built in. A very tough clip. One so tough that if you wear those cute scrubs with the flared legs and the knit waistline you can forget trying to spread the clip enough to get it to attach to your pants. But I adapted by figuring out how to wear it on a waist-level pocket. Now my biggest issue is leaning close to patients and inadvertently turning the light off at the black side switch. I really think it was better on the top when it was red and adjacent to the intensity knob.

Opinion #4: There’s no excuse for not using a headlight.

I’m just going to think I’m better than you if you don’t have one. That’s my throwdown. If you use the excuse that headlights cost too much? Compare the Lumadent with its “better” competitors, it’s so much less expensive, you can buy one for you AND your assistant. And for your higher power loupes, for that matter. What about the problem with wires and bulk? The Lumadent is so lightweight that once you adjust your behavior a little (all I did was to begin wearing a strap on my loupes instead of taking them on and off so that they hang around my neck when I’m not using them) they will become a much easier part of you than having to reach up and adjust a mounted light somewhere over your right shoulder, in space. And patients stop anticipating the bright light and never squint anymore when it’s time to open their mouths. PATIENT ACCEPTANCE IS AMAZING, and in my opinion, the BEST reason why you should get a Lumadent.

This is my parting shot for you, a side view of the Lumadent attached to a pair of Through-The-Lens shielded SandyGrendel loupes with the custom mount that came with the light. See how it sticks up a little too high, and there are two tie-wraps, and a cord management doohickey making this all such a mess?

No? I don’t see it either, actually.

For earlier insights about Lumadent and the company, click here to go to the DentalBuzz original review.

It looks like virtual reality may actually be almost Matrix-quality in a few short years, and our patients will be able to immerse themselves fully in another world while they’re getting their dental work done. But because there’s a lot more money to be made in gaming (and there’s a MUCH wider customer base) don’t expect that this technology will have a dental application any time soon. Here’s a decent introduction to the concept featuring Palmer Luckey, the originator of the Oculus Rift headset:

These sorts of glasses have been intriguing to me for years, but all the previous versions mentioned here on DentalBuzz basically make it seem like you’re watching a TV screen from a distance. Oculus Rift is different. Users have described the feeling as being totally disconnected from reality. And isn’t that what recreational drugs do? Isn’t that what dental sedatives do?

Imagine a dental appointment where a fearful patient is allowed to slip into a virtual playground where they don’t even need to move their head much in order to initiate the immersive feeling of being elsewhere while they hold their totally oblivious mouths open. Patients’ ears will hear the sounds of their “other world,” letting them slip away from their bodies for a little while so that you can manage all the dental unpleasantries for them.

Here’s another preview of Oculus Rift:

There are many software developers in dentistry that are in search of the next big thing. The 3-D milling technology is pretty awesome these days, but indirect dental software such as patient education, practice management and the like are also looking for the leg-up. Oculus Rift is looking for developers right now, and my guess is that they haven’t even imagined its application in dentistry.

Don’t you think that this is the WORST part of orthodontia? You take off the brackets and voila! Straight teeth… with fugly white squares where acid beat the $#!† out your patients’ anteriors. And NOW you have to go drill on their teeth, destroying what you so carefully tried to perfect.

Once you’re here there’s no use in blaming the patient; it’s not like they’re going to get the brackets put back on to cover the white spots and then get more decalcification there. Yes, you should help them with their lifestyle choices (less energy drinks and voluntary mouth breathing, please) but at this point you have to do something to make them look better.

As a hygienist I’ve been totally itching for about the last four years to get the go-ahead to use a relatively new product called an infiltrant. There’s only one, it’s made by DMG and it’s called Icon. This infiltrant is placed on the tooth where it seeps into smooth-surface lesions that haven’t fully cavitated (although if you ask me the ones in the “Before” picture above look way gnarled out) and pretty much does a little remineralization voodoo.

I’d hoped that it would be classified as a sealant because Yay! I can do sealants. There’s no drilling done, right? There’s nothing taken away, right? There is, however, some irreversible improvement made to the tooth though and that (plus a significant etch time) means that when the CDT recognized that an infiltrant needed a code, where did that boom fall? Smack dab into Composite Land as a D2990. I know. The wording says “placement of an infiltrating resin restoration for strengthening, stabilizing and/or limiting progression of the lesion” and that SCREAMS prevention. Alas there’s the other word. Restoration.

Dangit.

Another problem is that this stuff is very expensive. See what it costs here for the mini kit for a maximum of six lesions?

That’s at best, $27 per tooth just for the kit (not including your other overhead or minusing the limited-time Amex card!). The suggested cost to a patient should be somewhere between your one surface composite fee and a sealant fee, and conservatively it takes at least 20 minutes of intense doctor time to place an infiltrant on a single tooth. Composites don’t cost that much or take that long to place so you know what that means, right? THE FEASIBILITY OF ICON SUCKS.

I really hope I’m wrong, but to most doctors, what’s a few millimeters of drilled-away tooth structure? Minimally invasive dentistry is for anal retentive freak dentists anyway. And every hygienist who has ever had a passion for preserving tooth structure, including me.

So yeah, this is bad news for Icon and for DMG, really. Sure, they got a CDT code this year but it’s not like anyone is going to use it. There’s like one dentist in a 5o mile radius that’s even ordered it around here. I know this because you can look on the DMG patient portal here and find a dentist that offers Icon in your area.

I have a challenge then. Actually two challenges – one for dentists, and the other for those who want to see this service added to the hygienist’s scope of practice in every state.

•If you’re a dentist and you love saving teeth, JUST DO THIS. Charge what you must, you’re not going to get rich, but you will have the warm fuzzy feeling that you’re doing the right thing by preserving tooth structure. We all know composites and amalgams eventually fail around their margins. There are no margins with an infiltration, just a lovely, arrested half-moon where an incipient lesion never progressed if you follow up with radiographs two decades from now (I may be exaggerating, but maybe not!). Go here, learn more, buy some.

•Those of you who are frustrated with dental hygienists wanting to become these mid-level providers that are supposed to help in low-access areas but will probably just come take your job away from you (I keed! I keed!) please support the use of infiltrants by hygienists. You will still need to diagnose that the treatment is needed but the service should be able to be delegated because of the very nature of the care being provided and the labor intensity needed for this smaller ROI.

As a realist, I don’t see squat happening as a result of this challenge. What can one blogger do? I have these silly dream glasses, when I put them on and see the future, well, there are no more cavities, on anyone, except arrested ones, and all the dentists are happy because all they have to do is play on the computer and nod their head every so often while their hygienists prevent all dental infirmities for ever and ever. Then I take them off again, and I see white spot lesions on teeth.

This holiday season, don’t you know someone who would appreciate the Photoshopped finesse that can only be found in a printed new year calendar? Especially if they are aficionados of the lip-less look of their favorite Dexter, typodont, or other practice mannequin.

It’s bad enough that we all had to hover over these our first semester of dental school. Now they’ll be entering your dreams in an Inception-like takeover of your subconscious fears. NO! YOU NEVER GRADUATED AND YOU MUST SAY THANK YOU FOR THE UGLY WALLET FROM THE FAKE EVIL WOMAN YOU MARRIED!

Please tell me that you don’t really want one of these calendars. If you insist, it is available at this link here at Practicon, for pretty cheap, for a gag, for someone you pretend to like but just want to oog out really really bad.

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DentalBuzz explores rising trends in dentistry with its own slant. The speed at which new products and ideas enter the dental field can often outpace our ability to understand just exactly the direction in which we are heading. But somehow, by being a little less serious about dentistry and dental care, we might get closer to making sense of it all.

So yeah, a tongue-in-cheek pun would fit really nicely here, but that would be in bad taste. Never mind, it just happened anyways. Stop reading sidebars already and click on some content instead.

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